Ross procedure in rheumatic aortic valve disease.

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Rheumatic Heart Disease Management

Background:

• Rheumatic heart disease frequently affects the aortic valve, necessitating surgical intervention.
• The Ross procedure, using a pulmonary autograft for aortic valve replacement, has been explored for these patients.
• Patient selection and outcomes in rheumatic heart disease populations undergoing the Ross procedure require further evaluation.

Purpose of the Study:

• To evaluate the efficacy and safety of the Ross procedure in patients with rheumatic heart disease.
• To compare outcomes between younger (<30 years) and older (>30 years) rheumatic patients undergoing aortic valve replacement.
• To assess the long-term results of pulmonary autograft use in this specific patient cohort.

Main Methods:

• A retrospective analysis of 81 rheumatic patients undergoing the Ross procedure with root replacement between 1993 and 2003.
• Inclusion criteria focused on patients with aortic valve disease due to rheumatic etiology.
• Data collection included demographics, associated procedures, early and late mortality, re-operation rates, and valve function.

Main Results:

• Early mortality was 7.4%, with a mean follow-up of 92.3 months.
• 82% of patients had no significant aortic regurgitation at follow-up.
• Re-operation was needed in 8.4% of patients, primarily for autograft dysfunction or mitral valve issues. Young rheumatics (<30 years) showed a higher risk of autograft dysfunction.

Conclusions:

• The Ross procedure is generally not suitable for young patients with rheumatic heart disease.
• Carefully selected older patients (>30 years) with isolated rheumatic aortic valve disease may experience acceptable mid-term outcomes.
• Pulmonary autograft use in this population warrants cautious consideration, especially in younger individuals.